Actions Requested

  • Have increased suspicion for acute hepatitis A among people with acute onset of jaundice, markedly elevated liver function tests, and other symptoms of acute viral hepatitis. Especially in those who are homeless and/or using drugs.
  • Perform serologic testing on suspect cases- hepatitis A IgM; or acute hepatitis panel.
  • Provide hepatitis A vaccine to patients who are homeless and/or using drugs, if they have not yet been vaccinated.
  • Report suspect cases to (253) 798-6410 immediately.


A large hepatitis A outbreak is occurring in three California counties: San Diego, Santa Cruz and Los Angeles. The majority of cases are among homeless people and/or people using drugs. The mode of transmission during this outbreak is person to person, due to crowded conditions and lack of sanitary facilities where homeless people are living. Reported hospitalizations and deaths are elevated, likely reflecting co-morbidities such as chronic hepatitis B, chronic hepatitis C, or alcohol-related cirrhosis. Of the 564 cases reported as of Sept. 29, 380 (67%) have been hospitalized and there have been 17 deaths.


At this time, we have had no cases of hepatitis A in Pierce County since May 2017. However, the California outbreak spread to Maricopa County, Arizona earlier this year when a person from San Diego traveled there and received services for the homeless, resulting in 15 cases Feb.-May 2017. In Pierce County, we have had 0-4 cases per year since 2011 (one so far in 2017). Washington typically has had fewer than 50 hepatitis A cases (0-1 fatal) reported in recent years including 2017.


The virus is spread through feces from infected persons. The incubation period is 2-6 weeks; typically, persons become ill 3-4 weeks after exposure. Persons are communicable 14 days prior to onset of jaundice until 7 days post onset. Infants and very young children typically show no symptoms, but can spread the virus to others. Household and close contacts should receive post exposure prophylaxis with hepatitis A vaccine or immune globulin, coordinated by Health Department nurses.


One dose of hepatitis A vaccine is very effective in offering protection within 2-4 weeks. A second dose is recommended 6 months after the first for full protection.

Call (253) 798-6410 for immediate assistance.